The AFL Demonstration Program was enacted to provide local communities and institutions with workable models of prevention programs that discourage premarital adolescent sexual relations and care programs that reduce the negative consequences of adolescent pregnancy. To develop these models, AFL authorized grants for three types of demonstrations: (1) projects which provide "care services" only (i.e., services for the provision of comprehensive services to pregnant adolescents, adolescent parents, and their families); (2) projects which provide "prevention services" only (i.e., services to promote abstinence from adolescent premarital sexual relations); and (3) projects which provide a combination of care and prevention services.

The demonstration projects were multi-year projects (3 to 5 years), renewable annually. As of March 1988, 97 demonstration projects had been funded. Each demonstration project has an internal evaluation component designed to test hypotheses specific to that project's service delivery model. Projects were evaluated by an independent evaluator contracted by each grantee. Evaluators were usually affiliated with a college or university in the grantee's state.

Data Set B9 was collected as an evaluation of the Certified Nursing Midwifery (CNM) Program of the Maternal & Family Health Services, Inc., in Wilkes-Barre, Pennsylvania. The project began in October 1982 with Adolescent Family Life care program funding. The project provides care services to a predominantly white population of pregnant and parenting adolescents. In this evaluation, the hospital-based outpatient care program with a Health Visitor component is compared with the hospital-based project clinic operation before the Health Visitor component was given a major role. The evaluation focuses on teen pregnancy outcomes and postnatal care. The data cover clients registered from April 1982 through May 1986 and have been divided into two periods. The pre-treatment, or comparison group, covers April 1982 through August 1983; the treatment, or study group, covers February 1984 through May 1986. In the comparison group, the role of the Health Visitor was minimal; usually the Health Visitor became involved only after the birth of the child. In the study group, the Health Visitor became involved early on in the pregnancy and had a much more comprehensive role.

The project offers pregnancy testing, prenatal and postpartum health care, nutritional and social services counseling, as well as the Health Visitor program. Although services are provided to male partners and family members as well, the data contain information only regarding the pregnant or parenting female adolescent. The surveys included questions on respondent demographic characteristics, pregnancy and childbirth history, contraceptive methods and behaviors, medical complications, pregnancy risk factors, delivery complications, and program involvement at different follow-up periods.

The actual intervention of the program is as follows. All new clients are given a pamphlet on adoption at their first prenatal visit (see Appendix D). The pamphlet was developed by the project to introduce adolescents to adoption and to invite their exploration of this option. A Health Visitor provided support and counseling through the baby's first birthday. The Health Visitor contacts included clinic and hospital visits, telephone calls, family planning and well-baby visits, and home visits. In the comparison group, the Health Visitor was to have contact with the client at least four times--in the hospital directly after delivery, 4 weeks after delivery, 6 months after delivery, and 12 months after delivery. In the study group, Health Visitors were to become involved with pregnant adolescents early in the pregnancy. The Health Visitor had contact with the client at her first visit to the clinic, when she was 5 months pregnant, at delivery, and at 6 weeks, 3 months, 6 months, and 12 months after delivery, as well as at any time the pregnant or parenting adolescent was in need of the Health Visitor's services. The role of Health Visitors is to encourage and assist young parents to remain in or return to school; make use of family planning methods; enroll in vocational classes or a job training program; learn about baby care, budgeting, and meal preparation; and secure housing, WIC, and financial assistance. By establishing a solid bond with the client prior to delivery, the Health Visitor lays the foundation for an ongoing relationship.

An advisory committee, consisting in part of pregnant and parenting adolescents and their family members, meets regularly to provide feedback to the project on its services. As a result of the committee's recommendations, the project added parenting classes, which grandparents and fathers were also invited to attend, to its services.